右美托咪定对冠状动脉旁路移植病人术后认知功能障碍的影响

    Effect of different doses of dexmedetomidine on the postoperative cognitive dysfunction in patients treated with coronary artery bypass transplantation

    • 摘要:
      目的评价不同剂量右美托咪定对冠状动脉旁路移植病人术后认知功能障碍(POCD)的影响。
      方法择期行冠状动脉旁路移植术病人120例,采用随机数字表法、双盲法将病人分为右美托咪定不同的给药剂量组(D1组、D2组和D3组)和对照组(C组),每组30例。麻醉诱导前30 min D1组、D2组和D3组静脉输入右美托咪定,负荷剂量分别为0.2、0.4和0.8 μg/kg,随后以0.5 μg·kg-1·h-1的速率至术毕,C组给予等容量0.9%氯化钠溶液。于入室后麻醉诱导前(T0)、CPB开始后(T1)、CPB结束(T2)、术毕(T3)、术后24 h(T4)及术后72 h(T4)6个时间点采集静脉血检测血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、神经元特异性烯醇化酶(NSE)及中枢神经特异蛋白(S100β)水平。术前1 d,术后1、3、7 d分别进行MMSE评分同时统计POCD发生率。
      结果相比C组,T1~T4时D1组、D2组和D3组TNF-α、IL-6、NSE及S100β水平水平均显著降低(P < 0.05),POCD发生率更低(P < 0.05)。D1组、D2组和D3组病人术后1 d和3 d时病人MMSE评分更高于C组(P < 0.05)。
      结论术前给予右美托咪定能显著降低冠状动脉旁路移植病人POCD的发生率,其可能与降低炎症反应密切相关,在临床应用剂量下与POCD发生率无剂量相关性。

       

      Abstract:
      ObjectiveTo evaluate the effects of different doses of dexmedetomidine on the postoperative cognitive dysfunction(POCD) in patients treated with coronary artery bypass transplantation.
      MethodsOne hundred and twenty patients scheduled by coronary artery bypass transplantation were divided into the different doses of dexmedetomidine group(group D1, group D2 and group D3) and control group(group C) using the random number table method and double-blind method(30 cases in each group).At 30 min before induction of anesthesia, the dexmedetomidine was intravenously administered to group D1, D2 and D3 with loading doses of 0.2, 0.4 and 0.8 μg/kg, respectively, and then at a rate of 0.5 μg·kg-1·h-1 until the end of operation.The group C was given the equal volume 0.9% sodium chloride solution.Before induction of anesthesia after entry(T0), at the beginning of CPB(T1), at the end of CPB(T2), after operation(T3), after 24 h of operation(T4) and after 72 h of operation(T5), the serum levels of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), neuron-specific enolase(NSE) and central neuron-specific protein(S100β) were detected in all cases, the MMSE scores before 1 day of operation, and after 1, 3 and 7 d of operation were evaluated, and the incidence rate of POCD was calculated.
      ResultsThe levels of TNF-α, IL-6, NSE and S100β in group D1, group D2 and group D3 were lower than those in group C(P < 0.05), and the incidence rates of POCD in group D1, group D2 and group D3 were significantly lower than those in group C(P < 0.05).The MMSE scores in group D1, group D2, and group D3 after 1 and 3 days of surgery were higher than those in group C(P < 0.05).
      ConclusionsPreoperative administration of dexmedetomidine can significantly reduce the incidence rate of POCD in patients treated with coronary artery bypass transplantation, which may be closely related to the reduction of inflammatory response, and there is not dose correlation with the incidence rate of POCD at the clinical dose.

       

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